Analysis of Growth, Nutritional Status and Hospital Visitation Scores Associated with Reflux After Nissen Fundoplication in Neurologically Impaired Children with Gastroesophageal Reflux.

BACKGROUND: Neurologically impaired children (NIC) often experience swallowing difficulties and gastroesophageal reflux disease (GERD). Although these conditions could place children in a state of poor nutritional status and prevent them from thriving, there is insufficient research evaluating growth and nutritional status following fundoplication in these patients.

METHOD: This is a retrospective study of patients who were neurologically impaired and underwent Nissen fundoplication between April 2001 and March 2015. Seventy-six patients were enrolled, and the follow-up period was 12 months or longer. Growth was measured by the change in body weight and height. Nutritional status was measured by the change in body mass index, serum albumin and protein level.

RESULTS: Median age at operation was 1.85 years old, and median body weight was 10 kg. The respective Z scores for weight and height showed significant improvements after 1 year since the operation compared to 1 year within the operation (-2.42 ± 2.19 vs. -1.31 ± 1.96, P < 0.001) (-1.6 ± 2.16 vs. -1.05 ± 1.69, P = 0.002). The respective Z scores for body mass index, albumin and protein also showed improvements after 1 year since the operation compared to 1 year within the operation (-2.07 ± 2.99 vs. -0.89 ± 2.1, P < 0.001) (3.55 ± 0.48 vs. 3.86 ± 0.45, P < 0.001) (6.22 ± 0.76 vs. 6.65 ± 0.51, P < 0.001). Hospital visitation scores associated with reflux were significantly lower after the operation (4.1 ± 3.43 vs. 1.18 ± 1.67, P < 0.001).

CONCLUSIONS: In summary, after Nissen fundoplication in NIC with GER, growth and nutritional status improved significantly. Also, hospital visitation scores associated with reflux decreased after the operation.